| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,247 |
11,143 |
$395K |
| D0120 |
Periodic oral evaluation - established patient |
12,669 |
12,568 |
$313K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,332 |
1,509 |
$312K |
| D1206 |
Topical application of fluoride varnish |
15,256 |
15,111 |
$306K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,581 |
1,668 |
$269K |
| D1110 |
Prophylaxis - adult |
3,419 |
3,396 |
$168K |
| D1351 |
Sealant - per tooth |
4,373 |
1,466 |
$157K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,058 |
3,867 |
$128K |
| D0272 |
Bitewings - two radiographic images |
5,876 |
5,824 |
$124K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
841 |
275 |
$108K |
| D0330 |
Panoramic radiographic image |
1,261 |
1,260 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
577 |
330 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,399 |
1,394 |
$57K |
| D0145 |
Oral evaluation for a patient under three years of age |
945 |
940 |
$30K |
| D0274 |
Bitewings - four radiographic images |
949 |
937 |
$29K |
| D8660 |
|
192 |
192 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
520 |
509 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,302 |
1,283 |
$16K |
| D0240 |
|
407 |
404 |
$14K |
| D0350 |
|
257 |
255 |
$8K |
| D0470 |
|
97 |
96 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
239 |
232 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
52 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$379.24 |